Article

Contextual influences on modern contraceptive use in sub-Saharan Africa.

Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Ga 30322, USA.
American Journal of Public Health (Impact Factor: 4.23). 08/2007; 97(7):1233-40. DOI: 10.2105/AJPH.2005.071522
Source: PubMed

ABSTRACT We examined the role of community-level factors in explaining geographic variations in modern contraceptive use in 6 African countries.
We analyzed Demographic and Health Survey and contextual data sources with multilevel modeling techniques to identify factors contributing to geographic variations in women's use of modern contraceptives.
We found significant associations between several community-level factors and reported use of modern contraceptive methods. We also identified several pathways of influence between the community and the individual.
Aspects of a community's sociocultural and economic environment appear to influence a woman's use of modern contraceptive methods.

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    ABSTRACT: This study takes a multilevel approach to identify determinants of women’s use of modern contraceptives in two diverse settings, Nepal and Rwanda. We explore the extent to which four spheres of communitylevel influence—socioeconomic development, women’s empowerment, fertility norms, and access to family planning information and services—shape women’s contraceptive use, after adjusting for women’s individual socio-demographic characteristics and for other contextual factors. Data for this study come primarily from the 2011 NDHS and the 2010 RDHS, and also draw from spatial data sources to measure community levels of socioeconomic development. The study focuses on rural women who do not wish to have a child within the next two years, a subset of women of particular interest to family planning policymakers. A sequence of random-effects logit regression models are run— separately for Rwanda and Nepal—to examine the variation in modern contraceptive use explained by each of the four selected spheres of community-level influences. A final model includes all four sets of community-level variables, as well as individual-level factors. In the final model for both Rwanda and Nepal, community-level variables in each of the four spheres remain significant predictors of women’s current use of modern contraception. After adjusting for women’s individual characteristics, the community’s level of socioeconomic development, the extent to which women in the community participate in decisions around family planning, prevailing small-family size norms, and the community’s access to modern methods appear to be positively associated with women’s contraceptive use. Overall, results from this study indicate the relevance for family planning programs of the community context in which women live. The demand for family planning services is influenced not only by women’s individual and household characteristics, but also by the community’s socioeconomic development, its access and exposure to family planning, the gender norms of local community members regarding decision-making for family planning and health issues, and community norms regarding marriage and childbirth. Among the factors we explored, the analysis suggests that socioeconomic development and access to family planning services may play a bigger role in affecting women’s contraceptive behaviors than the community’s norms regarding gender and fertility.

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